Background: Patients with chronic liver disease are immunocompromised and prone to different opportunistic infections. Fungal infections in patients admitted with liver cirrhosis are not rare and they may increase mortality and morbidity of these patients. Aims of the study is to determine the mortality and its risk factors associated with fungal infections in patients with chronic liver disease.Methods: In this retrospective study, patients admitted with chronic liver disease during the last four years on this hospital were studied for diagnosed fungal infections. A matched control group of cirrhosis patients with a ratio of 1:2 admitted without fungal infections was also studied and mortality was compared between the two groups.Results: Seventy admitted patients of liver cirrhosis with microbial and histopathological evidence of fungal infection were found while 140 patients of the control group had no evidence of fungal infection. Hepatitis C virus infection was the major cause of cirrhosis (65%) and most of the patients were in child class C(63%). Urinary tract infection, esophageal candidiasis, and mucormycosis were major fungal infections. Mortality was much higher in the fungal infections group (34.3%) as compared to the non-infectious group (16%). On multivariate analysis, high WBCs count, hypo-albuminemia and high creatinine levels were the worst factors affecting mortality.Conclusions: Fungal infections are a significant cause of morbidity and mortality in patients with decompensated cirrhosis. Advanced cirrhosis, renal insufficiency, and leucocytosis are independent predictors of fatal outcome in these patients.
Irritable bowel syndrome (IBS) is a gastrointestinal disease of intestinal mobility. IBS present with variable clinical symptoms making the treatment difficult. IBS is quiet prevalent around the globe with different frequency. Differences in frequency and gender is due to diet habit. It is less frequent where diary product and vegetable are frequently consumed as compared to those who consumed meat. Lactobacillus plantarum 299v (L. plantarum 299v) is the most widely studied strain in the IBS patients. It is resistant to the actions of intestinal acids and bile, colonizes the human colonic mucosa and is non-pathogenic in nature. The efficacy of Lactobacillus plantarum 299v L is different in different study. The present study was designed to find the efficacy of Lactobacillus plantarum 299v in comparison to placebo in randomized control trial.
Background: Screening studies for hepatitis C have proved that it is more prevalent in patients with renal diseases. Chronic hepatitis C infection in patients with kidney disease not only accelerates renal deterioration but also adversely effects morbidity and mortality. Availability of direct acting antiviral drugs has revolutionized treatment of hepatitis C even in difficult patients. In advanced kidney diseases, selection of treatment is difficult. Aim of this study was to evaluate the efficacy and safety of Sofosbuvir based DAAs in patients with advanced CKD.Methods: In this Quasi experimental study, CHC patients with or without cirrhosis having advance CKD (eGFR <30 ml/min per 1.73 m2) and/or on dialysis were enrolled. End points of the study were documentation of SVR 12 or discontinuation of therapy. Different regimens of oral DAAs with or without Ribavirin were used.Results: 86 patients with a median age of 53 years were enrolled. 37 patients were on maintenance dialysis and 49 were not on dialysis with eGFR <30 ml/min per 1.73 m2. Virological response was 92.68% at the end of treatment and SVR was achieved by 90.2% twelve weeks after therapy. Insomnia 14%, headache 11% and anemia 7% were main dverse effects. Mean eGFR and creatinine before and after treatment remained the same. Only 2 patients relapsed, both were on dialysis thrice weekly.Conclusions: All Sofosbuvir based regimens used for the treatment of CHC in patients with end stage renal disease are effective and well tolerated. Close follow up is advised to monitor side effects.
A bstract Background Chronic hepatitis C (CHC) management has changed tremendously after direct-acting antivirals (DAAs) availability. Sustained virological response (SVR) has improved significantly, but one of the major concerns is the chances of de novo hepatocellular carcinoma (HCC) development after DAAs. The objective of the study is to calculate the frequency of newly diagnosed cases of HCC after antiviral therapy for CHC in Pakistan. Materials and methods This prospective, interventional research was conducted from June 2017 to September 2020. All patients after antiviral therapy for CHC were followed with an ultrasound abdomen and α-fetoprotein, six monthly. Multiphasic computed tomography (CT) of the abdomen was performed in suspected cases. For quantitative variables, the mean and standard deviations were calculated, whereas the qualitative variables were analyzed by frequencies and percentages. Results Among 180 patients, 110 were men and 70 were women with a mean age of 45.52 ± 11.71 years. One hundred and twenty-six patients were noncirrhotic, 38 had compensated cirrhosis while 16 had decompensated cirrhosis. One hundred and sixty-four (91.11%) patients achieved SVR, of which 22 (12.22%) patients developed new HCC during follow-up. Compensated cirrhosis group had 10 patients, the decompensated group had 12 patients, and the noncirrhotic group had no new HCC cases. Among patients with the new HCC, 12 achieved SVR. Conclusion The risk of the development of HCC after antiviral treatment is highly significant among patients with liver cirrhosis. So, a strict surveillance strategy should be adopted in every cirrhotic patient following treatment with DAA agents even if they achieve SVR. Clinical significance Chances of developing HCC are still significantly high even after achieving SVR with DAAs in patients with liver cirrhosis. Patients with liver cirrhosis should be under surveillance for HCC even after achieving SVR after DAAs treatment. How to cite this article Rasool S, Hanif S, Ahmad A, et al . Frequency of De Novo Hepatocellular Carcinoma after Direct-acting Antiviral Therapy for Chronic Hepatitis C: A Prospective Follow-up. Euroasian J Hepato-Gastroenterol 2022;12(2):73–76.
Irritable bowel syndrome (IBS) is a gastrointestinal disease of intestinal mobility. IBS present with variable clinical symptoms making the treatment difficult. IBS is quiet prevalent around the globe with different frequency. Differences in frequency and gender is due to diet habit. It is less frequent where diary product and vegetable are frequently consumed as compared to those who consumed meat. Lactobacillus plantarum 299v (L. plantarum 299v) is the most widely studied strain in the IBS patients. It is resistant to the actions of intestinal acids and bile, colonizes the human colonic mucosa and is non-pathogenic in nature. The efficacy of Lactobacillus plantarum 299v L is different in different study. The present study was designed to find the efficacy of Lactobacillus plantarum 299v in comparison to placebo in randomized control trial. MethodOne hundred and ninety patients were assessed for eligibility 46 among them were excluded from the study and twenty four declined to participate in the study. One hundred and twenty patient of IBS was grouped in two different groups. The one was treated with Lactobacillus plantarum 299v and the other was treated with placebo. Symptoms of IBS, like abdominal pain, bloating and complete rectal emptying was noted and interpreted among the groups. Results There was no statistically significant difference in relieving abdominal pain, bloating, rectal emptying in Lactobacillus plantarum 299v treated group and placebo treated group. Conclusion This randomized control trail of Lactobacillus plantarum 299v fail to show signicant efficacy in IBS treatment as compared to placebo.
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